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Doctor's Consultation  by Dr. Iain Corness


Do you need insurance?

I have just renewed my medical insurance, for myself, my wife and the children.  Whilst I hate giving anything away (my Scottish heritage comes forth at times when I have to open the wallet), I have to say the premium was not expensive, and far less than I would pay in the western world.

However, if you haven’t upgraded your cover recently, then you may be in for a nasty surprise.  Unfortunately, everything, be that petrol, bread, or baby’s nappies has gone up in price in the past 12 months.  If you haven’t upgraded there could be a shortfall, which you have to find (or fund), not your insurance company.

I have also been very lucky with my choice of careers.  Being a medico does have advantages.  If I couldn’t fix my skin rash or whatever, I could always ring a classmate who could (or should) be able to.  Medications and drugs?  Again no worries, just a quick raid of the samples cupboard in my surgery and I had everything I needed.  Insurance not needed.  (One of my medical friends used to say that after diagnosing some condition in his family, he would go to his samples cupboard.  If he couldn’t find what he wanted, he would change the diagnosis to use some medication he did have!  True.)

What about hospital in-patient insurance?  I passed on that one too.  After all, the only foreseeable problems that could stop me working were massive trauma following a road accident or suchlike, or a heart attack.  In either case you don’t care where you are as long as there are wall to wall running doctors and plenty of pain killers.  In Australia, the “free” public hospital system is fine for that.

So I blithely carried on through life insuranceless.  I did spend one night in hospital with a broken leg 30 years ago, so as regards personal medical costs versus proposed insurance premiums, I was still miles in front.

And then I came to Thailand.  Still I blithely carried on, after all, I was ten foot tall and bullet proof.  Then a friend over here had a stroke and required hospitalisation.  Said friend was four years younger than me and I was forced to review the ten foot bullet proof situation to find I was only five foot eleven and my anti-kryptonite had expired.  Thailand was a completely new ballgame.

Enquiries as to hospital and medical costs showed that they were considerably less than the equivalent in Oz, but, and here’s the big but, there’s no government system or sickness benefits to fall back on.  Suddenly you are walking the tightrope and there’s no safety net to stop you hitting terra firma.

So I took out medical insurance.  Still it was no gold plated cover.  But it was enough to look after me if I needed hospitalisation, and that came sooner than I imagined.  I had always subscribed to the “major trauma” theory, but two days of the galloping gut-rot had me flat on my back with the IV tube being my only life-line to the world.  We are only mortal - even us medicos.

Do you have medical insurance?  Perhaps it is time to chat to a reputable insurance agent!  Yes, reliable insurance agents and reliable insurance companies do exist, but you need help through the minefield.

You also need help when it comes to filling out the application forms, in my opinion.  And you also need to be 100 percent truthful.  Yes, insurance companies will check on your records, and if it is found that you have been sparing with the truth over pre-existing conditions, expect a shock at settling up time at the cashier’s desk.

Remember too, that just because you have an insurance card does not automatically signify that ‘everything’ is covered.  This is why private hospitals will ask you for a deposit on admission.  If the insurance company later verifies that you are indeed covered for that ailment or condition, then you’ll get it back, but you have to prove that you are covered, not the other way round!

And remember to check out your insurance agent.

Cattle Class Syndrome and Aspirin

As the Xmas break approaches, many of you will be getting ready to fly overseas (well, as long as you aren’t flying Qantas this week).  However, no matter what airline you choose, anybody who flies - regularly or just the annual travelers, is in danger of getting the “Economy Class Syndrome.”  This is a condition that has become prevalent with the advent of ‘long haul’ sectors, but fortunately, there are ways to prevent this happening, so read on.

Getting right down to tin-tacks, the Economy Class Syndrome is just a fancy title for a very common condition called Deep Venous Thrombosis, or more simply, a blood clot in a deep vein in the legs.  We shorten this to DVT, because we doctors like acronyms, and what’s more they easier to spell than the long names.

DVT’s occur not just in plane passengers, but in hospitals in the post operative period.  In fact, the latest figures from Australia would indicate that 50 percent of people who have orthopaedic surgery are likely to get a DVT.  Even 20 percent of general surgery patients are in line for this condition.  These are not large DVT’s I hasten to add, but are demonstrable in the blood, without their producing clinical symptoms.

And all that gets me back to my daily medication, prescribed for me by the new generation’s hope for salvation, the young Dr. Jonathan Corness, a new breed medico, about whom I am very proud - but I digress.  Dr. Jonathan prescribed one of the oldest medications in the world for me - Aspirin.  So why would this up-to-the-minute medico prescribe something as old hat as Aspirin?  Quite simply, because it works!  (Which is not something I can say without hesitation about some of the drugs available these days.)

In therapeutic doses to stop headaches and relieve arthritis, we are looking at something between 300-600 mgms four times a day for most people and Aspirin works well here. However, at that dosage you run the risk of upsetting your stomach, to actual bleeding and ulceration.  There are also people who show allergic reactions to Aspirin, from asthma right the way through to anaphylactic shock and death!  Yes, this is potent medicine.

However, there are other conditions for which Aspirin is the drug of choice, and not in the big doses either.  We are talking here of 100 mgm doses taken once a day only.  This way the chances of allergy/asthma and gastric bleeding are greatly reduced.  What the Aspirin does is work on the aggregation of platelets.  This is where the red blood cells sort of form into clumps and these become clots and are the start of the Deep Vein Thromboses (DVT’s).  And this is what happens in the Economy Class Syndrome, if you are unlucky.

Now medical science has found that by taking 100 mgm of Aspirin daily you lower your chances of heart attack, something much higher on my personal risk table than Economy Class Syndrome.  You see, clotting can occur in many areas of the body, and a clot in the coronary arteries can be extremely life threatening.  And life shortening!  And yet so easily avoided, with one little tablet every day.  You can buy baby Aspirin, but I used “Cardiprin” - this is more expensive, but comes in a push-through calendar pack, which gets me to remember to take it better than just a bottle of tablets on the breakfast table.  However, if it is your pocket you wish to look after, as well as your cardiovascular system, then the 81 mg Baby Aspirin tablets will do the trick (just remember to take one a day!)

Now getting back to flying, the secret to health in the air is purely to maintain good circulation and avoid dehydration.  To maintain circulation to the lower legs you should get up and walk around the plane once every hour.  Choose an aisle seat so you can get in and out easily.  The relative dehydration is also easy to fix - drink more water, not more alcohol!  So on the hourly walk, stop at the kitchen area and ask for a drink of water.  That’s it!  Simple.  Have a great flight.

Check-ups 50 percent off

I just had my own annual checkup last month, and I am pleased to say that everything is looking good.  The little extra weight I had last year has gone, and the cholesterol has come down with it.

My annual medical check-up is an important part of my planning for the future, a future with a good Quality of Life.  Check-ups are inherently involved in the Quality of Life.  Longevity alone, with no quality, just isn’t worth it in my book.

Many people work on the principle that they would rather not know about any underlying or sinister medical conditions they may have.  After all, we are all going to die one day, aren’t we?  I have always said that despite all advances in medical science, the death rate will always be the same - one per person!  But wouldn’t you rather have pleasant final years than one of poor health, infirmity and aches and pains?

The guiding principle behind check-ups is to find deviations from normal health patterns at an early stage.  Early enough that the trend can be reversed, before damage has occurred.  Examples of this include Blood Pressure (BP), as high BP can affect many organs in the body, not just the heart.  But an elevated BP generally gives no warning symptoms.

Another example is blood sugar.  Again, it requires sky-high sugar levels before the person begins to feel that something might be wrong.  And by then the sugar levels have affected vision, the vascular system and many other systems, all of which can decrease your future Quality of Life.  Amputation of a limb is a common result of unchecked blood sugar levels.

Cardiac conditions and abnormalities, be that in anatomy or function, can also very adversely affect your Quality of Life, but are very easily found during a routine check-up.  Various blood tests and an EKG can show just how well the cardiac pump is functioning, and how well it will continue to function in the future.  The inability to walk more than 50 meters certainly takes the fun out of shopping, yet this can be predicted - if you have some serial records!

Another of the silent killers can be discovered in your lipid profile, with Cholesterol and its fractions HDL and LDL, being intimately connected with your cardiac status.

Let me give you an example.  A younger man who was obviously overweight, but played golf three times a week and had no apparent problems.  He enjoyed his golf, and the beers at the 19th hole.  Just like his overweight golfing mates.

This chap’s blood tests were not so good, and his diabetic tendency was now more than just a tendency.  Despite the fact that he was not having chest pains, he decided to have the 64-Slice CT of the coronary arteries carried out.  This showed three blockages.  Three corrective stents later he could return to the golf course, but with urgent recommendations to get his weight down and get his blood sugar and cholesterol under control.

There are actually so many conditions that can affect your enjoyment of the future that can be discovered early.  Renal (kidney) function and liver function can be monitored through an annual check-up, as can prostate size (indicated by the PSA blood test) or breast tumors (by mammogram).

Hopefully you are now thinking about an annual check-up. Catch anything early and you have given yourself the chance to correct it - and get a better Quality of Life in the forthcoming years.